Chapter 15 Gastrointestinal System

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Chapter 15 Gastrointestinal System Dr. LL Wang E-mail: wanglinlin@zju.edu.

1 Chapter 15 Gastrointestinal System Dr. LL Wang Rm 608, Block B, Research Building, School of Medicine, Zijingang Campus

2 Pancreatic Secretion

3 The exocrine cells in the pancreas play a central role in the production of digestive enzymes; the endocrine functions of the pancreas will be discussed at length in Chapter 16.

4 (I) Pancreatic juice ph 7.8~8.4 ~1500 ml/day Isosmotic Components: Pancreatic digestive enzymes: secreted by pancreatic acini Sodium bicarbonate: secreted by small ductules and larger ducts

5 Were digestive enzymes synthesized in their active form, they would digest the very cells that make them. Hence, inactive precursors (e.g., trypsinogen) become activated (trypsin).

6 Secretion of bicarbonate ions Secreted by the epithelial cells of the ductules and ducts that lead from acini Up to 145mmol/L in pancreatic juice (5 times that in the plasma) Neutralizing acid entering the duodenum from the stomach

8 Secretion of pancreatic digestive enzymes Carbohydrates -- Pancreatic amylase Pancreatic lipase Fat Cholesterol esterase Phospholipase Trypsinogen Proteins Chymotrypsinogen Procarboxypolypeptidase Proelastase

9 Starches Pancreatic amylase Maltose and glucose polymers

12 Trypsin Inhibitor Inhibits the activity of trypsin and thus guards against the possible activation of trypsin and the subsequent autodigestion of the pancreas

13 Acute pancreatitis

14 Acute pancreatitis

15 (II) Regulation of pancreatic secretion Basic stimuli that cause pancreatic secretion Ach Cholecystokinin: Secreted by I cells Stimulates the acinar cells to secrete large amounts of enzymes Secretin: Released by S cells Acts primarily on the duct cells to stimulate the secretion of a large volume of solution with a high HCO 3- concentration

16 Secretin s receptors are found in the pancreas, which responds with additional bicarbonate delivery: gastric motility and secretion are inhibited.

17 Cholecystokinin s receptors are located: in the pancreas, which responds with additional enzyme delivery in the gallbladder, which contracts to deliver more bile in the sphincter of Oddi, which relaxes to facilitate delivery of the enzymes and bile salts

18 Phases of pancreatic secretion Cephalic Phase: taste of food- long parasympathetic pathways Gastric Phase: distension of stomach- long parasympathetic reflex pathways Intestinal Phase The most important regulators are CCK and secretin Acid, fats, amino acids, peptides and protein are the main stimulus for pancreatic production and secretion

19 Bile Secretion and Liver Function

20 Composition of bile HCO - 3 Bile salts Lecithin Cholesterol Bile pigments Trace metals

21 Function of bile (1) Bile are critical for digestion and absorption of fats and fat-soluble vitamins Bile salts are facial amphipathic

22 A molecular model of a bile salt, with the cholesterol-derived core in yellow. A space-filling model of a bile salt. The non-polar surface helps emulsify fats, and the polar surface promotes water solubility.

23 Bile salts and phospholipids convert large fat globules into smaller pieces with polar surfaces that inhibit reaggregation Emulsification

24 Emulsified fat globules are small enough that lipase enzymes gain access to degrade triglycerides to monoglycerides and fatty acids

25 Big Droplets of Fat Small Droplets of Fat Micelles Fatty Acids and Monoglycerides Chylomicron Assembly Distribution and Processing

26 (2) Eliminate many waste products Excrete bile pigments or drug metabolites "Looking at you with a jaundiced eye" Bilirubin (useless and toxic breakdown product of hemoglobin)

27 (3) Prevent the precipitation of cholesterol in the gallbladder and eliminate excess cholesterol 90% of gallstones are of cholesterol stones

28 (4) Increasing bile synthesis & secretion Up to 95% of the cholesterol-based bile salts are recycled by reabsorption along the intestine Enterohepatic circulation (5) neutralize the stomach acid

29 Regulation of bile secretion Substances increasing bile production 1) Bile salts 2) Secretin 3) Cholecystokinin 4) parasympathetic input

30 Small Intestine Secreted by Brunner's glands of duodenum ph ~3 L/day Isosmotic Components H 2 O Electrolytes (Na +, K +, Ca 2+, Cl - ) Mucus IgA Enterokinase

31 Most of the contractions of the small intestine are of the mixing and churning actions portrayed here as segmentation contractions; peristalsis and the downstream movement of materials is infrequent.

32 Absorption in the gastrointestinal tract

33 (I) Basic principle of absorption Almost all absorption of nutrients occurs in the small intestine

34 1. Absorptive surface of small intestinal mucosa Total area of 250 m 2 : Folds: 3-fold Villi: 10-fold Microvilli: 20-fold

35 2. Absorption pathways transcellular route paracellular route

36 3. Absorption mechanisms Active transport Diffusion Solvent drag

37 (II) Absorption of major nutrients 1. Water and Electrolytes H 2 O: osmosis, diffusion Na + : Cotransporter Carrier-mediated facilitated diffusion

38 Ca 2+ : Ca 2+ pump

39 2. Carbohydrates Mainly in the form of monosaccharides 80%

40 (1) Glucose and galactose: Secondary active transport (cotransport with sodium) (2) fructose: facillitated diffusion

41 3. Proteins In the form of dipeptides, tripeptides and a few free amino acides

42 (1) Amino Acids and Peptides : Secondary active transport (2) A few amino acids: facilited diffusion

43 4. Fats Triacylglycerol Emulsification Hydrolysis Micelles

44 (1) Absorption through lymph duct to the circulatory blood fatty acids and monoglycerides micelles bump into epithelial cell form new triglycerides transport in lymph chylomicron lacteal

45 (2) Direct absorption into the portal blood Short- and medium chain fatty acids (more watersoluble)

46 Summary Pancreatic secretion (including the composition and physiological function of the pancreatic juice, the regulation of pancreatic secretion) Biliary secretion (including the composition and physiological function of the bile) Absorption in the small intestine Describe the digestion of carbohydrates, proteins and fat

47 Intensive reading Textbook of Human Physiology P

Physiology Unit 4 DIGESTIVE PHYSIOLOGY

Physiology Unit 4 DIGESTIVE PHYSIOLOGY In Physiology Today Functions Motility Ingestion Mastication Deglutition Peristalsis Secretion 7 liters/day! Exocrine/endocrine Digestion Absorption Digestion of